SLS 21RS-434 ORIGINAL
2021 Regular Session
SENATE BILL NO. 191
BY SENATOR CLOUD
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE POLICIES. Provides relative to coverage of certain physician-administered
drugs and related services. (gov sig)
1 AN ACT
2 To enact Part X of Subchapter D of Chapter 5-D of Title 40 of the Louisiana Revised
3 Statutes of 1950, to be comprised of R.S. 40:1227.1 through 1227.3, relative to
4 provider-administered drugs; to provide for legislative intent; to provide for
5 definitions; to provide for access; to provide for payment to participating health care
6 providers; to provide with respect to penalties; and to provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. Part X of Subchapter D of Chapter 5-D of Title 40 of the Louisiana
9 Revised Statutes of 1950, to be comprised of R.S. 40:1227.1 through 1227.3, is hereby
10 enacted to read as follows:
11 PART X. PROTECTING PATIENT ACCESS TO
12 PHYSICIAN-ADMINISTERED MEDICATIONS
13 §1227.1. Purpose and intent
14 The purpose and intent of this Part is to ensure patient access to
15 physician-administered drugs and related services furnished to persons covered
16 under a health insurance contract. This Part shall ensure that health insurance
17 issuers do not interfere with patients' freedom of choice with respect to
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 191
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1 providers furnishing physician-administered drugs and ensure that patients
2 receive safe and effective drug therapies.
3 §1227.2. Definitions
4 For purposes of this Part, the following words shall have the following
5 meanings:
6 (1) "Covered person" shall have the same meaning as provided in R.S.
7 22:1019.1.
8 (2) "Health insurance issuer" shall have the same meaning as provided
9 in R.S. 22:1019.1.
10 (3) "Participating provider" shall have the same meaning as provided
11 in R.S. 22:1019.1.
12 (4) "Physician-administered drug" means any prescription drug as
13 defined in R.S. 22:1060.1, other than a vaccine, that requires administration by
14 a provider and is not approved as a self-administered drug.
15 §1227.3. Physician-administered drugs; access; payment
16 A. A health insurance issuer shall not refuse to authorize, approve, or
17 pay a participating provider, including any clinic, hospital outpatient
18 department, or pharmacy under common ownership or control with the
19 participating provider, for providing covered physician-administered drugs and
20 related services to covered persons. A health insurance issuer shall not
21 condition, deny, restrict, refuse to authorize or approve, or reduce payment to
22 a participating provider for a physician-administered drug because the
23 participating provider obtains physician-administered drugs from a pharmacy
24 that is not a participating provider in the health insurance issuer's network. The
25 drug supplied shall meet the supply chain security controls and chain of
26 distribution set by the federal Drug Supply Chain Security Act, Pub. L. 113-54,
27 as amended. The payment shall be at the rate set forth in the health insurance
28 issuer's agreement with the participating provider applicable to such drugs, or
29 if no such rate is included in the agreement, then at the wholesale acquisition
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1 cost. A health insurance issuer shall not require a covered person pay an
2 additional fee, higher copay, higher coinsurance, second copay, second
3 coinsurance, or any other increased cost-sharing amount for a physician-
4 administered drug when provided by a participating provider.
5 B. A pharmacy benefit manager or person acting on behalf of a
6 pharmacy benefit manager shall not condition, deny, restrict, refuse to
7 authorize or approve, or reduce payment to a pharmacy or pharmacist for
8 providing covered physician-administered drugs and related services to an
9 enrollee. The reimbursement shall be at the rate set forth in the contract
10 between the pharmacy benefit manager or person acting on behalf of a
11 pharmacy benefit manager with the pharmacy or pharmacist applicable to the
12 drugs, or if no rate is included in the agreement, then at the wholesale
13 acquisition cost. A pharmacy benefit manager or person acting on behalf of a
14 pharmacy benefit manager shall not require an enrollee to pay an additional
15 fee, higher copay, higher coinsurance, second copay, second coinsurance, or any
16 other increased cost-sharing amount for a physician-administered drug when
17 provided by a pharmacy, pharmacist, clinic, hospital, or hospital outpatient
18 department.
19 C. The commission of any act prohibited by this Part shall be considered
20 an unfair method of competition and unfair practice or act which shall subject
21 the violator to any and all actions, including investigative demands, private
22 actions, remedies, and penalties, provided for in the Unfair Trade Practices and
23 Consumer Protection Law.
24 D. Any provision of a contract that is contrary to any provision of this
25 Part shall be null, void, and unenforceable in this state.
26 Section 2. This Act shall become effective upon signature by the governor or, if not
27 signed by the governor, upon expiration of the time for bills to become law without signature
28 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
29 vetoed by the governor and subsequently approved by the legislature, this Act shall become
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Coding: Words which are struck through are deletions from existing law;
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1 effective on the day following such approval.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Cooper.
DIGEST
SB 191 Original 2021 Regular Session Cloud
Proposed law prohibits a health insurance issuer from refusing to authorize, approve, or pay
a participating provider for providing covered physician-administered drugs and related
services to covered persons. Further prohibits a health insurance issuer from conditioning,
denying, restricting, refusing to authorize or approve, or reducing payment to a participating
provider for a physician-administered drug because the participating provider obtains
physician-administered drugs from a pharmacy that is not a participating provider in the
health insurance issuer's network. Requires that the drug supplied meets the supply chain
security controls and chain of distribution set forth by the federal Drug Supply Chain
Security Act.
Proposed law requires payment to a participating provider to be at the rate set forth in the
health insurance issuer's agreement with the provider applicable to such drugs. If no rate is
included in the agreement, the payment shall be at the wholesale acquisition cost.
Proposed law prohibits a health insurance issuer from requiring a covered person pay an
additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any
other increased cost-sharing amount for a physician-administered drug when provided by
a participating provider.
Proposed law prohibits a pharmacy benefit manager or person acting on behalf of a
pharmacy benefit manager from conditioning, denying, restricting, refusing to authorize or
approve, or reducing payment to a pharmacy or pharmacist for providing covered
physician-administered drugs and related services to an enrollee. Reimbursement shall be
at the rate set forth in the contract between the pharmacy benefit manager or person acting
on behalf of a pharmacy benefit manager with the pharmacy or pharmacist applicable to the
drugs, or if no rate is included in the agreement, then at the wholesale acquisition cost.
Proposed law prohibits a pharmacy benefit manager from requiring an enrollee to pay an
additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any
other increased cost-sharing amount for a physician-administered drug when provided by
a pharmacy, pharmacist, clinic, hospital, or hospital outpatient department.
Proposed law requires the commission of any act prohibited by proposed law to be
considered an unfair method of competition and unfair practice or act which shall subject
the violator to any and all actions, including investigative demands, private actions,
remedies, and penalties as provided in present law.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 40:1227.1-1227.3)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.